Provider Demographics
NPI:1851395461
Name:OH, ALICE S (OD)
Entity Type:Individual
Prefix:DR
First Name:ALICE
Middle Name:S
Last Name:OH
Suffix:
Gender:F
Credentials:OD
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Mailing Address - Street 1:15478 MEHERRIN DR
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20120-3711
Mailing Address - Country:US
Mailing Address - Phone:703-774-8849
Mailing Address - Fax:240-465-0069
Practice Address - Street 1:12110 SUNSET HILLS RD
Practice Address - Street 2:#50
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-5852
Practice Address - Country:US
Practice Address - Phone:703-834-9777
Practice Address - Fax:703-834-8187
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2016-03-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0618001473152W00000X
MDTA1781152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAV10979Medicare UPIN